Tracking Growth in Children

00:01 In this lecture we're going to discuss tracking growth in children, and short stature, and how we handle that problem.

00:08 So we do as a result of primary care, frequent checks of children during their life at 0, 2, 4, 6, 9, and 12 months and then on through childhood after that.

00:24 When we're seeing these children, we're frequently seeing them and recording their various parameters.

00:31 Early in life we do head circumference, weight, and height.

00:35 And then later on, we do mostly just the weight and the height and we're calculating things like BMI.

00:42 So here?s two growth charts that we'll use.

00:44 We usually use the WHO or World Health Organization Charts until the age of 2, and there?s one for boys and one for girls.

00:51 And we'll plot the height and weight of these children to make sure things are going okay.

00:56 After or 2, there?s another set of growth charts that we'll use like these which are really more prescribed by the CDC.

01:04 So we also track in addition to weight and height, in the early childhood we'll track head circumference.

01:13 Here?s a hypothetical child you might see with an abnormal head circumference.

01:18 You can see why following overtime is important.

01:22 In this child, this child was doing very well in terms of their appropriately growing head circumference until about the age of 9 months when the head circumference really started expanding.

01:32 This child perhaps has a new onset hydrocephalus or increased pressure of the cerebrospinal fluid in the brain which is causing the head circumference to gradually expand more than you would like.

01:45 By tracking it, we get a sense of where this child is intentionally going and then going from there when it changes as per what we would expect.

01:57 So in this case, we might be concerned about this child and perceive with more tests because we've been tracking their growth and development.

02:05 Following weight is critical and can give you clues about disordered eating, from obesity to eating disorders and many different medical diseases as well.

02:17 So there are thousands of reasons why children might fail to gain weight or gain weight too much.

02:23 And the age at which children start to either fall off or go up on their growth curves is critical to understanding exactly what the problem is.

02:32 So for example, here is a child who?s growing along in their growth curves.

02:38 You can see the top line, which is their height, has been going pretty well.

02:43 It's been tracking appropriately along about the 50th percentile.

02:48 In this child, they were perhaps 75th percentile weight which is fine until an age, right here you can see it, where the weight really started tailing off.

02:59 This sort of pattern is classic for a disease where a child has increased metabolic demand.

03:05 For example, perhaps this child has just developed Crohn?s disease.

03:10 This child might have increased metabolic demand and a decreased absorption of nutrients causing the weight to start to fall off.

03:20 In general, children who have caloric insufficiency will preserve their height at the expense of their weight early as things go.

03:30 But if they continue to starve or continue to have increased metabolic demand, the height will start to tail off later as well.